肾移植排斥反应时血糖皮质激素监测的意义

目的了解肾移植受者发生超急性、加速性、急性排斥反应时体内内源性及外源性糖皮质激素（GC）的变化情况及意义。方法采用高效液相色谱法对33例发生排斥反应者及39例无排斥者血内源性及外源性糖皮质激素进行动态监测。以氢化可的松（HC）为内源性糖皮质激素代表，以糖皮质激素残余率(RR)标化HC变化。结果无排斥组的HC为（0.034±0.022）μmol/L，RR为0.062±0.041；2例超急性排斥者的HC为0.493μmol/L，RR＞1.0；1例加速性排斥者的HC为0.200μmol/L，RR为0.53；30例急性排斥者的HC为（0.205±0.158）μmol/L，RR为0.458±0.384。各类型排斥之HC、RR与无排斥组比较，差异均有显著性（P＜0.05）。急性排斥者在糖皮质激素冲击治疗时其HC、RR下降大致平行，但耐糖皮质激素性排斥者的下降速度较糖皮质激素敏感性排斥者缓慢。发生急性排斥者，其血中外源性糖皮质激素的浓度与无排斥者比较，差异无显著性（P＞0.05）。结论内源性糖皮质激素的变化可作为排斥反应的诊断指标及判断排斥反应对糖皮质激素冲击治疗是否敏感。

Implication of monitoring of serum glucocoticoids level in rejection of renal allograft

Objective　To investigate the clinical value of serum glucocorticoids (GC) level monitoring in rejection episodes ( hyperacute rejection, accelerated rejection, acute rejection ) of allograft recipients. Methods　The levels of serum GC including endogenous (hydocortisone, HC) and exogenous (dexamethasone, Dex) in 33 cases of rejection and 39 cases of no-rejection were dynamically measured by high performance liquid chromatography (HPLC). Results　The HC level and adrenal function residual rate ( RR=serum HC level after transplantation/serum HC level before transplantation) in no-rejection group were (0.034±0.022)!μmol/L and 0.062±0.041 respectively; 0.493!μmol/L and RR＞1.000 respectively in hyperacute rejection (2 cases); 0.2!μmol/L and 0.53 respectively in accelerated rejection (1 case); (0.234±0.165)!μmol/L and 0.485±0.384 in GC sensitive acute rejection (GCSAR); (0.154±0.150)!μmol/L and 0.252±0.242 respectively in the GC resistant acute rejection (GCRAR). The HC levels and RR values of any kinds of rejection episode were higher than in the no-rejection group (P＜0.05). The decrease of HC and RR during intensive therapy was approximately parallel. The decreased speed of HC and RR in GCRAR was slower than GCSAR. There was no significant difference in exogenous GC concentration between acute rejection and non-acute rejection (P>0.05). Conclusions　The change in endogenous GC can served as a diagnostic index of rejection and the decreased speed of endogenous GC can be used to predict the sensitivity of acute rejection to GC.